Healthcare Provider Details

I. General information

NPI: 1992098792
Provider Name (Legal Business Name): SARA LOUISE SNYDER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 07/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 NE 16TH AVE SUITE B
PORTLAND OR
97232-1413
US

IV. Provider business mailing address

3804 N HAIGHT AVE APT 15
PORTLAND OR
97227-1339
US

V. Phone/Fax

Practice location:
  • Phone: 503-880-9533
  • Fax:
Mailing address:
  • Phone: 503-880-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC153780
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: